EKG CASE STUDY #5: 75YO Cancer Patient Witnessed Cardiac Arrest

SCENARIO

You and your partner are working in an urban ALS service. At 0430, you are dispatched to an unresponsive party at a private residence, and are told en route by dispatch that the patient is possibly in cardiac arrest. An engine is dispatched for manpower, and arrives to the residence at the same time as your commission. Family members lead your crew through a crowded house upstairs to find your patient, a 75YOM, in full cardiac arrest. The patient’s wife states that the only know medical history that the patient has is prostate cancer and HTN; wife goes on to state that the patient was speaking to her around 0425, and appeared restless; mid-sentence the patient collapsed to the floor. Per family on scene, the patient is a full code.

MEDICATIONS

Flomax

Opana

Lisinopril

ALLERGIES

NKDA

INITIAL INTERVENTION

Chest compressions initiated

OPA/NRB @15lpm placed per local protocol

No secretions or obstructions noted in airway

INITIAL RHYTHM

Patient presents in VF; 1st defibrillation @360J

Compressions resumed

Tibial IO established; 1.omg of 1:10,000 Epi

2mg IO Naloxone administered due to Opana usage

Blood glucose assessed: 114mg/dl

FIRST PULSE CHECK

Patients persists in VF; 2nd defibrillation @360j

Compressions resumed

300mg IO push Amiodarone

250ml NS bolus

SECOND PULSE CHECK

Patient persists in VF; 3rd defibrillation @360J

Chest compressions continued

Second 250ml NS bolus initiated

1.0mg 1: 10,000 Epi push

King LT placement

Capnography placed with initial reading of 39

THIRD PULSE CHECK

Patient presents in VF; 4th defibrillation @360J

Chest compressions continued

150mg IO Amiodarone push

Third 250ml NS push

Halfway through CPR cycle, EtCO2 spikes to 72

Patient begins to exhibit purposeful movement of the upper extremities